The Sexual Function Evaluation Questionnaire (SFEQ) to Evaluate Effectiveness of Treatment for Sexual Difficulties: Development and Validation in a Clinical Sample

Figures & data

Table 3. Sample information (n = 486)

		n	%
Gender	Female	223	45.9
	Male	263	54.1
Ethnic group	White	302	62.1
	Indian/Pakistani/Bangladeshi	23	4.7
	Black/Caribbean/African	41	8.4
	Mixed/Other	47	9.7
	Asian	14	2.9
	Missing	59	12.1
Age (years)	<20	8	1.7
	20–29	194	39.9
	30–39	161	33.1
	40–49	66	13.6
	50–59	41	8.4
	60+	16	3.3
Sexual orientation	Bisexual	10	2.1
	Heterosexual	265	54.5
	Missing	211	43.4

Table 1. Distribution of responses, Natsal-SF clinical version (n = 486)

Sexual problems	Frequency (%)
	Never	Not very often			Sometimes		Very often	Always/did not have sex last month due to this
1) Felt anxious during sex*	11.2	12.8			24.4		26.0	25.6
	Distress
	Not a problem	Not at all distressed			A little distressed		Fairly distressed	very distressed
2) Lacked interest in having sex	24.0	12.0			21.9		26.7	15.4
3) Lacked enjoyment in having sex	23.5	9.1			22.6		26.5	18.4
4) Felt physical pain as a result of sex	41.8	11.0			12.4		15.0	19.8
5) Felt no excitement or arousal during sex	28.5	11.2			20.2		23.8	16.4
6) Did not reach a climax	28.1	14.3			21.7		19.8	16.2
7) Reached a climax more quickly than would like	51.2	14.9			13.6		8.9	11.4
8) Erectile problems (men)/dry vagina(women)	21.5	9.3			15.8		23.9	29.6
Sexual relationship with partner	Agree strongly	Agree			Neither agree nor disagree		Disagree	Disagree strongly
9) My partner and I share about the same level of interest in having sex	11.8	20.0			14.5		34.9	18.8
10) My partner and I share the same sexual likes and dislikes	13.7	39.5			27.7		16.0	3.1
11) My partner has experienced sexual difficulties in the last month	10.6	16.9			11.0		28.7	32.7
	Always	Most of the time			Sometimes		Not very often	Hardly ever
12) Feel emotionally close to partner when engage in sex together	35.7	39.1			16.8		5.5	2.9
Perceptions of sex life	Agree strongly	Agree			Neither agree nor disagree		Disagree	Disagree strongly
13) I feel satisfied with my sex life	2.6	6.0			15.9		42.8	32.8
14) I feel distressed or worried about my sex life	32.8	47.5			10.6		5.3	3.8
15) I have avoided sex because of sexual difficulties (my own or partner’s)	27.2	35.3			13.9		14.8	8.8

These distributions exclude missing information. There was missing information for 11–14% of NSFC problem distress items, 47–51% of NSFC partner relationship items (these were only applicable to patients having a regular sexual partner for the past month), 3–4% of NSFC sex life items and 1% of NSOG items.*Because anxiety and distress overlap conceptually, frequency rather than distress was used to score severity on this item.

Table 2. Distribution of responses NSOG items (n = 486)

	11-point response scale (%)
	0	1	2	3	4	5	6	7	8	9	10
	Not important										Important
1) How important is your sex life to you?	1.0	0.2	1.4	1.7	2.1	3.3	3.5	17.1	22.7	14.4	32.6
	Not severe										Severe
2) How severe is your sexual problem?	0.8	0.6	2.7	3.3	2.7	10.2	8.7	21.4	19.1	12.5	17.9
	Poor										Good
3) What is the quality of your sexual life?	16.2	7.1	11.9	17.5	9.2	10.6	12.3	6.2	5.0	2.1	2.1
	Not confident										Confident
4) How sexually confident are you?	11.6	5.6	9.5	13.9	10.2	13.7	11.8	9.8	6.6	3.5	3.7
	Not well										Well
5) How well does your body work sexually?	11.3	6.7	13.5	15.6	10.6	11.7	8.5	9.4	6.7	2.9	3.1
	Not satisfied										Satisfied
6) How satisfied are you with your sex life?	22.2	10.6	16.6	13.5	9.1	10.4	8.5	4.4	2.1	1.5	1.2
	Not distressed										Distressed
7) How distressed are you by your sexual problem?	0.8	1.7	5.2	4.6	4.3	5.6	8.7	15.3	19.2	15.1	19.6
	Not confident										Confident
8) How confident do you feel engaging in sexual activity?	11.2	6.9	13.1	10.8	10.8	12.1	11.0	10.2	4.8	4.8	4.4

For the main analyses, NSOG item responses were combined as follows: 0/1 = 1, 2/3 = 2, 4/6 = 3, 7/8 = 4, 9/10 = 5. These distributions exclude missing information. There was missing information for 1% of NSOG items.

Table 5. Factor structure and loadings for a combined NSFC/NSOG instrument derived from confirmatory factor analysis (analytic sample = 486)

Factor	Item*	Factor loading
Factor 1: Problem distress (NATSAL Q2,3,5 plus 6, 7, 4, 8; Table 1)	Distress due to no interest in sex	0.75
	Distress due to no enjoyment of sex	0.78
	Distress due to no excitement/arousal	0.75
	Distress from no climax; climax quicker than would like; pain; or erectile difficulties/vaginal dryness (whichever causes the most distress)	0.50
Factor 2: Partner relationship (NATSAL Q9,10,12; Table 1)	share same level of interest in sex	0.76
	share same sexual likes and dislikes	0.63
	feel emotionally close to partner during sex	0.40
Factor 3: Overall sex life (NATSAL Q13,14,15; Table 1)	Satisfied with sex life	0.66
	Distressed by sex life	−0.62
	Avoided sex	−0.73
Factor 4: Sexual confidence (NSOG Q4,5,8; Table 2)	Sexually confident	0.82
	How well body works well sexually	0.64
	Confident engaging in sexual activity	0.88
Overall sexual function	Factor 1	0.59
	Factor 2	0.54
	Factor 3	0.90
	Factor 4	−0.69

Higher scores for factors 1, 2, and 3, and lower scores for factor 4, denote lower sexual function. In the overall measure, higher scores denote lower function.*

Table 4. Primary clinician diagnosis by patient gender*

		n	%
Men	Erectile difficulties/disorder/dysfunction	137	52
	Hyposexual desire disorder	21	8
	Early ejaculation	47	18
	Delayed ejaculation	20	8
	Partner has sexual difficulties	8	3
	No diagnosis	30	11
Women	Genito-pelvic pain/penetration disorder	131	59
	Anorgasmia	25	11
	Sexual interest/arousal disorder	14	6
	Partner has sexual difficulties	11	5
	Anaerobic bacterial vaginosis	1	0
	No diagnosis	41	18

*The distribution of diagnoses in part reflects that the clinic was primarily able to offer treatment for Erectile Difficulties (men) and Genito-Pelvic Pain/Penetration Disorder (women).

Table 6. Associations between combined measure and patient anxiety, depression, and substance use

	Outcome (sample prevalence %)
	Moderate anxiety (n = 217) (31%)		Severe anxiety (n = 217) (13%)		Depression (n = 222) (26%)
	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p
Combined NSFC/NSOG	2.29 (1.20– 4.40)	.012	7.17 (2.46– 20.90)	<.001	2.05 (1.04– 4.03)	.037
Sample size	217		217		222

Moderate anxiety: GAD7 score 10+, Severe anxiety GAD7 score 15+, depression PHQ9 score 10+. Models were all adjusted for gender and age. OR = odds ratio, CI = confidence interval, p = probability

Table 7. Mean change in the overall and subscale scores over five therapy sessions, among patients in different age groups

	Age 18–29 (n = 45)			Age 30–74 (n = 61)
	gMean change (SD)	p-value	Effect size	Mean change (SD)	p-value	Effect size
Problem distress	−0.59 (0.84)	<.001	0.7	−0.25 (0.83)	.021	0.3
Partnerrelationship	−0.23 (0.53)	.006	0.4	−0.14 (0.56)	.063	0.2
Sex life	−0.31 (0.72)	.005	0.4	−0.14 (0.50)	.028	0.3
Sexual confidence	−0.62 (0.66)	<.001	0.9	−0.32 (0.67)	<.001	0.5
Overall measure	−0.35 (0.47)	<.001	0.7	−0.17 (0.40)	.002	0.4

Figure 1. Change in SFEQ subscales over five sessions, n = 106.